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Introduction: In 2014, traumatic brain injury (TBI) caused 3 million ER visits, hospitalizations, and deaths in the US. The National Institute for Health and Care Excellence (NICE) guidelines, initially generated using data from patients presenting within 24 h of head trauma, are used to determine the need for head computed tomography (CT) scan in patients after 24 h. The authors wanted to determine the proportion of CT scans for head trauma performed at our center in late presenters (>24 h after head trauma), the incidence of intracranial pathology in early (24 h) versus late (>24 h) presenters, and the sensitivity of the NICE guidelines for TBI in these two subpopulations. Methods: A retrospective chart review was conducted at a tertiary care center in Karachi. All people (>16) who had a head CT for head trauma from 2010 to 2015 were included. Age, sex, primary diagnosis, comorbid disorders, mechanism-of-injury, duration (in hours) from head trauma to presentation, site, and extent of injury (injury severity scale), hospital stay, number and details of surgical procedures, CT scan findings, other injuries, and mortality were recorded. Means were compared using the Independent Sample t-test, while categorical variables were compared using χ2. Multivariate logistic regression analyses were used to identify TBI predictors. Results: The authors found 2009 eligible patients; seven were excluded due to incomplete medical records. The final statistical analysis comprised 2002 head trauma patients. Overall, 52% of early and late presenters had severe injuries, and 2.3% died. 32.2% of patients with head trauma had CT after 24 h. Early presenters were 46.7% traumatized, while late presenters were 63%. The NICE guidelines were 93% sensitive for early presenters and 83% for late presenters with traumatic intracranial injury. Conclusion: Patients coming to the emergency department after 24 h of head trauma are a large proportion of the overall head trauma population. The NICE guidelines for late-presenting head injuries are less sensitive and may overlook intracranial injuries if imaging is not performed.
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INTRODUCTION: Peritoneal tuberculosis is difficult to diagnose as it may mimic peritoneal carcinomatosis, which has similar symptomatology. We sought to determine the diagnostic accuracy of computed tomography in differentiating peritoneal tuberculosis versus peritoneal carcinomatosis. MATERIALS AND METHODS: The associations of radiological findings in 124 patients with peritoneal carcinomatosis (n = 55) or tuberculosis (n = 69) were determined using Chi-square test. Sensitivity, specificity, positive and negative predictive value, and total diagnostic accuracy of CT imaging, with histopathology as gold standard, was determined. Subgroup analyses to determine these parameters by age (>40 years and ≤40 years) and gender (male and female) were performed. RESULTS: Mean age of study population was 44.1 ± 13.2 years with 61 males (49.2%) and 63 females (50.8%). The most common radiological abnormality in both peritoneal carcinomatosis (90.9%) and peritoneal tuberculosis (89.9%) was omental smudging, followed by presence of extraperitoneal mass (81.8%) in carcinomatosis and presence of micro-nodules in tuberculosis (88.4%). The findings significantly different in both the carcinomatosis and tuberculosis groups were high-density ascites, splenic calcification, splenomegaly, lymph node calcifications, micro-nodules, and macro-nodules. The diagnostic accuracy of CT in differentiating peritoneal tuberculosis from peritoneal carcinomatosis was 83.8%; sensitivity and specificity for peritoneal tuberculosis were 88.4% and 78.2%, respectively. CONCLUSION: The diagnostic accuracy of CT in differentiating peritoneal tuberculosis from peritoneal carcinomatosis revealed an overall diagnostic accuracy of 83.8%. Subgroup analysis revealed that CT may be a more specific diagnostic tool to predict peritoneal tuberculosis in female patients and in those over 40 years old.